| NPI | 1265722037 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: LA 301739) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 172662) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2017-05-03 |