| NPI | 1184615817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101236864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 21701) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2023-05-09 |