| NPI | 1255520466 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: GA 053065) |
| Additional Taxonomies | 261Q00000X (Licence: GA 053065) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2007-10-24 |