| NPI | 1255995601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024380) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-18-58809) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2023-03-17 |