| NPI | 1265005961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 1681609) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-21-151846) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2026-04-24 |