NPI | 1619202520 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 171000000X Military Health Care Provider (Licence: LA LPC #1580; LMFT #88) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA LMHC #60032033) |
Enumeration Date | 2009-10-09 |
Last Update Date | 2009-10-09 |