| NPI | 1083051478 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 96011121205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME122323) |
| 207Q00000X Family Medicine (Licence: FL TRN 18795) | |
| Enumeration Date | 2013-05-27 |
| Last Update Date | 2016-08-02 |