| NPI | 1699263665 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 4026418) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2025-01-21 |