| NPI | 1427626654 |
|---|---|
| Former Name | CARLY LEWIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA MD-55225) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: IA R-12195) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2025-07-07 |