| NPI | 1356478762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: KS 94-08890) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CT 000164) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2020-01-16 |