| NPI | 1780992172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: MD Mo4679) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL MA57798) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2011-11-02 |