| NPI | 1013363514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-03475) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 218223) |
| 207Q00000X Family Medicine (Licence: FL ME140690) | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2020-09-16 |