| NPI | 1679114797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MI 5601009495) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009495) |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2021-08-25 |