| NPI | 1013474642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 172A00000X Driver |
| 174200000X Meals | |
| 261QA0600X Clinic/Center Adult Day Care | |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2019-03-01 |