| NPI | 1124008776 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2013-01572) |
| 207Q00000X Family Medicine (Licence: NY 215878) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2019-07-04 |