| NPI | 1982206348 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11049873) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2026-08-10 |