| NPI | 1972904621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 45936) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: CT 045936) |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2019-11-08 |