| NPI | 1770012353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA10903100) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NJ 25MA10903100) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2024-01-09 |