| NPI | 1508809831 |
|---|---|
| Former Name | STEPHANIE LISA ROSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 31221) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IA 35919) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-11-21 |