| NPI | 1164534863 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 1810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS11437) |
| 207Q00000X Family Medicine (Licence: MI 5101007556) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2017-02-09 |