| NPI | 1508076514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: PA MD442300) |
| Additional Taxonomies | 2085R0001X (Licence: NC 2007-01809) |
| 2085R0001X (Licence: MA 212350) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2011-04-09 |