| NPI | 1962723304 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: VA 0104556804) |
| Additional Taxonomies | 111NR0400X (Licence: MD 03621) |
| 111NR0400X (Licence: MD S03621) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2019-09-03 |