| NPI | 1043621535 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2014-05-19 |