| NPI | 1205165297 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT012193) |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2021-06-08 |