| NPI | 1760588321 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 267712) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 4054) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2012-02-12 |