| NPI | 1902361447 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education |
| 133N00000X Nutritionist | |
| 261Q00000X Clinic/Center | |
| 261QH0100X Clinic/Center, Health Services | |
| 261QI0500X Clinic/Center, Infusion Therapy | |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2019-02-08 |