| NPI | 1194380683 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: UT 14206966-1205) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME149484) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2025-03-11 |