| NPI | 1902205859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain (Licence: MI 802619511) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant (Licence: MN 35952420140312) |
| Enumeration Date | 2014-08-16 |
| Last Update Date | 2021-06-14 |