| NPI | 1124089693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 32144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 99-00262) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-04-16 |