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 |