| NPI | 1912662107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 56475) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-21-182255) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-04-16 |