| NPI | 1083623672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NC 200100065) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200100065) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2017-04-20 |