NPI | 1710100888 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: LA 12053) |
Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: LA 12054) |
Enumeration Date | 2007-04-10 |
Last Update Date | 2010-10-05 |