| NPI | 1912519083 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 6472) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: LA 282572) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2020-08-20 |