| NPI | 1972299071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: CA 96000115) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: KS 96000115) |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-04-12 |