| NPI | 1801039656 |
|---|---|
| Former Name | SHANNON ALEXANDRA GULLIVER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 259217-1) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2014-03-20 |