| NPI | 1285045070 |
|---|---|
| Former Name | VIRGINIA BUSH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME148472) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 6896) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2021-01-25 |