| NPI | 1053366906 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME88121) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0088121) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2014-05-22 |