| NPI | 1497363212 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service |
| Additional Taxonomies | 305S00000X Point of Service (Licence: 000226) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2020-07-17 |