| NPI | 1578774865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OK 28891) |
| Additional Taxonomies | 2085R0001X (Licence: OH 57007866) |
| 2085R0001X (Licence: TX Q2524) | |
| 2085R0001X (Licence: CO 46111) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-03-02 |