| NPI | 1063413649 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME116431) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 29075) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2013-07-11 |