| NPI | 1780086025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: OR 314000000X) |
| Additional Taxonomies | 261QP0904X Clinic/Center, Public Health, Federal (Licence: OR 261QP0904X) |
| 261QV0200X Clinic/Center, VA (Licence: OR 261QV0200X) | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-09-18 |