| NPI | 1396143509 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: TX 760199836) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2014-12-22 |