| NPI | 1225109499 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: HI MAT-5497) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: HI MAT-5497) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2007-07-08 |