| NPI | 1619430832 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11022984) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 1979092) |
| Enumeration Date | 2019-04-14 |
| Last Update Date | 2023-02-07 |