| NPI | 1437708989 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: MT LMT-LMT-LIC-12394) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MT LMT-LMT-LIC-12394) |
| Enumeration Date | 2019-09-07 |
| Last Update Date | 2023-09-11 |