| NPI | 1881069425 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: 1014M0800X) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: 1014A0400X) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2015-12-08 |