| NPI | 1063621829 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 051698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 232049) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2024-05-07 |