| NPI | 1104264654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME128039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN18821) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2016-09-29 |