| NPI | 1902999436 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ 3315) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS 74515) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-09 |