| NPI | 1639448673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NV 00130) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NV 01245) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2011-12-20 |