| NPI | 1871936898 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NJ 25MA11415300) |
| Additional Taxonomies | 2085R0001X (Licence: PA MD477650) |
| 2085R0001X (Licence: AZ 59728) | |
| 2085R0001X (Licence: VA 0101264439) | |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2023-05-22 |