| NPI | 1194839464 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME105694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 7090) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2019-01-08 |