| NPI | 1093930133 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 24739)  | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 0001684)  | 
| Enumeration Date | 2007-04-16 | 
| Last Update Date | 2013-11-25 |