| NPI | 1942078464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CA 106E00000X) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: CA 103K00000X) |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2023-12-14 |