| NPI | 1124016118 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 1957) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 224963) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2011-02-22 |