| NPI | 1124083365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101010305) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101010305) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2012-05-02 |