| NPI | 1487195392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: NY 163WP0809X) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 386724) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2017-03-10 |