| NPI | 1174771844 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0805X (Licence: NC 9400230) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9400230) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2011-01-03 |