| NPI | 1073871646 |
|---|---|
| Former Name | ANISHA MARIE BOETEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA MD60648213) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA R-9498) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2021-04-16 |