| NPI | 1568664753 |
|---|---|
| Former Name | ANDREA MARTHA ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: FL ME 99350) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2007-09-10 |