| NPI | 1104860717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-01294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101239841) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-03-01 |