| NPI | 1386065589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 10562-33) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 1862-226) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2020-11-18 |