| NPI | 1114022597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101241970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116015753) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-01-19 |