| NPI | 1104087717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-01928) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: VA 0101247401) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2016-05-12 |