| NPI | 1861725251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: SC P27542) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: SC P27542) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2012-06-21 |