| NPI | 1053792747 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME140554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116028492) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2020-12-15 |