| NPI | 1407430382 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MA LN98236) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: MA LN98236) |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2021-05-07 |