| NPI | 1487943130 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NY 298541) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 298541) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2011-04-06 |