| NPI | 1710108758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: PA OC008482) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NJ 46TR00303100) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |