| NPI | 1508104076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2017-09-19 |