| NPI | 1023497997 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME138940) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN 21213) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2020-01-20 |