| NPI | 1558469601 |
|---|---|
| Former Name | MARIE ROSE BURGONIO DOMINGO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401016-1) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-02-20 |