| NPI | 1609305655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 89582) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX W3169) |
| 2084P0805X (Licence: GA 89582) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 64356) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2026-07-16 |