| NPI | 1104800051 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101256886) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 18471) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2014-11-17 |