| NPI | 1063643518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0420012480) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0600003776) |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2015-01-20 |