| NPI | 1215243274 |
|---|---|
| Former Name | FAEDRA BACKUS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2021-07-27 |