| NPI | 1205360120 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2023-01599) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-30874) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: NC 2023-01599) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2025-12-28 |