| NPI | 1114909926 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 1064131778) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME133995) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2022-01-17 |