| NPI | 1245058957 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: LA 111111) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: FL 111111) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: FL 111111) | |
| Enumeration Date | 2024-10-01 |
| Last Update Date | 2024-10-07 |