| NPI | 1649444159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: PA sw010344l) |
| Additional Taxonomies | 251S00000X (Licence: PA sw010344l) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2008-04-15 |