| NPI | 1104271725 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME157991) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101275453) |
| 208D00000X General Practice (Licence: PR 19319) | |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2024-02-12 |