| NPI | 1538282512 |
|---|---|
| Other Name | MARY WINIFRED NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0001X (Licence: CA C29521) |
| Additional Taxonomies | 2085R0001X (Licence: PA MD025567L) |
| 2085R0001X (Licence: KY 34754) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-08 |