| NPI | 1235221920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MO SW002668) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: MO SW002668) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2008-01-02 |