| NPI | 1124111091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 22467) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101238965) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2013-02-11 |