| NPI | 1053604728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 2651) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 2651) |
| Enumeration Date | 2011-05-27 |
| Last Update Date | 2022-01-27 |