| NPI | 1891068086 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: VA 0701005059) |
| Enumeration Date | 2012-02-17 |
| Last Update Date | 2012-02-17 |