| NPI | 1902323249 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: FL 240586) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: FL 240878) |
| 251S00000X Community/Behavioral Health (Licence: FL 240937) | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2025-09-16 |