NPI | 1245604461 |
---|---|
Former Name | TYSHANN MINGO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225400000X Rehabilitation Practitioner |
Additional Taxonomies | 102L00000X Psychoanalyst |
Enumeration Date | 2015-11-26 |
Last Update Date | 2018-05-03 |