NPI | 1639909567 |
---|---|
Former Name | CHARLOT K MAIN/STALLONE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 227048) |
Enumeration Date | 2024-08-06 |
Last Update Date | 2024-08-24 |