| NPI | 1568478014 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: CA G64905) |
| Additional Taxonomies | 2085R0001X (Licence: OR MD18221) |
| 2085R0001X (Licence: WA MD00034102) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-07-06 |