| NPI | 1205495314 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 101-0134433) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT F04190168) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2020-01-23 |