| NPI | 1104090141 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME109275) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 063333) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2015-07-17 |