| NPI | 1083470413 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MD LP54305) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2026-09-15 |