| NPI | 1619286127 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MI 4703117523) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: MI 225800000X) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2018-08-01 |