| NPI | 1164625539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14895) |
| Additional Taxonomies | 261QP2400X Clinic/Center, Prison Health (Licence: PR 14895) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2015-06-27 |