| NPI | 1588089395 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| 302F00000X Exclusive Provider Organization | |
| 305R00000X Preferred Provider Organization | |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2026-02-12 |