| NPI | 1184078420 |
|---|---|
| Former Name | BRETT CHANNING FORNELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SC 86670) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 2020-04798) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2023-10-02 |