| NPI | 1780051847 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: FL RN9232718) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: IN 28066933A) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2015-08-25 |