| NPI | 1053502799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME104445) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD20080070) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2010-12-27 |