| NPI | 1730633355 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT 91167) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 91167) |
| 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-91167) | |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2023-02-22 |