| NPI | 1124011754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 30580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 19167) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2015-03-18 |