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 |