| NPI | 1104808799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR BH0612108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 8352) |
| 207Q00000X Family Medicine (Licence: PR DM076216) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2012-11-01 |