| NPI | 1063440501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101252599) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0063731) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2019-01-08 |