| NPI | 1174948145 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101-0101897) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0101897) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2019-08-05 |