| NPI | 1598055352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: FL PTA 21980) |
| Additional Taxonomies | 171W00000X Contractor (Licence: OH PTA 06997) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2011-04-13 |