| NPI | 1922703552 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QE0002X Clinic/Center, Emergency Care |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-04-03 |