| NPI | 1124031265 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine | 
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY xa5051610)  | 
| Enumeration Date | 2006-08-13 | 
| Last Update Date | 2022-07-21 |