| NPI | 1114218567 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: LA MD.206939) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: LA MD.206939) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2016-10-05 |