| NPI | 1871038182 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: CO 225700000X) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2016-12-21 |