| NPI | 1093420093 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: WA 603411759) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: WA MC18127) |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2023-01-16 |