| NPI | 1114032034 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704113893) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301011628) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2025-09-11 |