| NPI | 1093186876 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: PR 12987) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: PR 12987) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2015-10-19 |