| NPI | 1043212228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 105981) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 31578) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2012-11-09 |