| NPI | 1962746198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: TN 0) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TN 0) |
| Enumeration Date | 2012-11-10 |
| Last Update Date | 2012-11-10 |