| NPI | 1902147085 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401638) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 631590-1) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2014-10-07 |