| NPI | 1790726875 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 167466) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME123956) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2019-03-05 |