| NPI | 1871914663 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2013044927) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2013044927) |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2025-02-12 |