| NPI | 1346711207 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry (Licence: VA 0110-0065421) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110-0065421) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2020-11-09 |