| NPI | 1962487173 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 110505) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 110505) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2014-04-03 |