| NPI | 1073951802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-01626) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 35791) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2021-05-26 |