| NPI | 1588826176 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: WA MD60419027) |
| Additional Taxonomies | 2086S0129X (Licence: NJ 25MA08116900) |
| 2086S0129X (Licence: CA A82191) | |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2016-03-21 |