| NPI | 1447715123 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center Developmental Disabilities (Licence: FL 312172) |
| Additional Taxonomies | 251E00000X Home Health (Licence: FL 30212442) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2023-05-17 |