| NPI | 1215283387 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: VA 0101254966) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101254966) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2020-06-26 |