| NPI | 1164969226 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402621) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 413173-1) |
| Enumeration Date | 2017-01-27 |
| Last Update Date | 2019-05-21 |