| NPI | 1003874199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD154795) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM 96359) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-01-24 |