| NPI | 1215370259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MI 6801103051) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2019-10-17 |