| NPI | 1013358142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME143948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 75548) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2020-11-03 |