| NPI | 1164634341 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042-0012141) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 00212104) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2011-05-27 |