| NPI | 1356478762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-43063) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 94-08890) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 000164) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2023-06-19 |