| NPI | 1831641935 |
|---|---|
| Former Name | ALISA DIANE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: PA L8-0010283) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2021-12-02 |