| NPI | 1790866218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: TX W0455) |
| Additional Taxonomies | 2085R0001X (Licence: ID M-14386) |
| 2085R0001X (Licence: WA MD60891438) | |
| 2085R0001X (Licence: MI 4301502877) | |
| 2085R0001X (Licence: WV 21385) | |
| 2085R0001X (Licence: NY 200842) | |
| 2085R0001X (Licence: MO 2021008778) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2025-08-25 |