| NPI | 1558921098 |
|---|---|
| Former Name | HOLLY JORDAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME161018) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MT218224) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-12-05 |