| NPI | 1922858091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 51139704) |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| 2085B0100X Radiology, Body Imaging (Licence: NY 51139704) | |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2025-11-26 |