| NPI | 1104303072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 59308) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 59308) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2023-03-21 |