| NPI | 1063873222 |
|---|---|
| Former Name | SUSAN JO WANDERMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NJ 26NJ00604400) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: NJ 26NJ00604400) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2025-04-18 |