| NPI | 1538521844 |
|---|---|
| Former Name | JESSICA GUSTAVSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WI 74734) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2021-06-30 |