| NPI | 1639554629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A137477) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: CA A137477) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2015-07-20 |