| NPI | 1124045174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A85065) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: CA A85065) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2010-07-12 |