| NPI | 1164643664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD159972) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420011763) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-03-29 |