| NPI | 1942615646 |
|---|---|
| Former Name | ELISA MARIE CRYSTAL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 312716) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036146202) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2024-05-13 |