| NPI | 1487795456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: MO 2005023703) |
| Additional Taxonomies | 171W00000X Contractor (Licence: KS 17-01026) |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2015-03-03 |