| NPI | 1619979366 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MD D0033082) |
| Additional Taxonomies | 2085R0001X (Licence: MA 54735) |
| 2085R0001X (Licence: TX H8900) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2007-11-05 |