| NPI | 1124281381 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2012-0030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 12122) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2015-10-09 |