| NPI | 1417039975 |
|---|---|
| Former Name | MARISSA LESLIE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA MD426645) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2014-04-11 |