| NPI | 1003817206 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 9958) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MT 9958) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-07-08 |