| NPI | 1811215205 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084D0003X (Licence: FL 131261) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 165149) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2019-06-11 |