| NPI | 1962054387 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402755) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NY 402755) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2023-03-10 |