| NPI | 1134565492 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: ME MD23596) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301102522) |
| 2086S0129X (Licence: NH 20463) | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2020-06-16 |