| NPI | 1174769954 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1292) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17452) |
| 261QP2300X Clinic/Center, Primary Care (Licence: PR 17452) | |
| Enumeration Date | 2008-12-27 |
| Last Update Date | 2022-10-20 |