| NPI | 1114068962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101230936) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 10131R) |
| 207R00000X Internal Medicine (Licence: CT 032514) | |
| 207R00000X Internal Medicine (Licence: RI MD7707) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2009-06-10 |