| NPI | 1356959027 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: 655491) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2025-10-07 |