| NPI | 1124216460 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: MI L416339004027) |
| Additional Taxonomies | 283X00000X Rehabilitation Hospital (Licence: MI L416339004027) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2007-10-11 |