| NPI | 1154764744 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0082757) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3152) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2018-01-17 |