| NPI | 1063585594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 11220) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 18072) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2012-03-29 |