| NPI | 1265908891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 171W00000X Contractor |
| 374K00000X Religious Nonmedical Practitioner | |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2018-10-22 |