| NPI | 1124094099 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD154529) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2002-01525) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2016-03-31 |