| NPI | 1629572102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NY 323218) |
| Additional Taxonomies | 2085R0001X (Licence: NJ 25MA11860500) |
| 2085R0001X (Licence: FL ME169760) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-07-25 |