| NPI | 1265566061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4426) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: AZ 7057360001) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2018-09-14 |