| NPI | 1154434462 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 15719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME T0649) |
| 207Q00000X Family Medicine (Licence: TN 2003) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2015-03-05 |