| NPI | 1104861970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 060130) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME95241) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2022-01-13 |