| NPI | 1760910301 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: CO 0012813) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CO 0012813) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2022-07-21 |