| NPI | 1043763865 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME140197) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10693) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2019-08-08 |