| NPI | 1003010307 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD214057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME111724) |
| 207Q00000X Family Medicine (Licence: NC 2007-00575) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2023-02-08 |