| NPI | 1376754499 |
|---|---|
| Former Name | SANDRA WILSON HERLICZEK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: MA 121025) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |