| NPI | 1609470780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R217915) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 06730) |
| 363L00000X Nurse Practitioner (Licence: MD R217915) | |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2023-03-06 |