| NPI | 1003112210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: MI 4301093338) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: MD D0068184) |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2011-02-04 |