| NPI | 1962991836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MA 1019881) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 171000000X Military Health Care Provider (Licence: VA 0101267521) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101267521) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2026-07-29 |