| NPI | 1174926679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101263837) |
| Additional Taxonomies | 174N00000X Lactation Consultant, Non-RN (Licence: VA 10421511) |
| 207Q00000X Family Medicine (Licence: MI 4301107153) | |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2021-11-30 |