| NPI | 1174973259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME144370) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-42512) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-08-04 |