| NPI | 1629545587 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 9533624) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-18-52857) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2020-07-27 |