| NPI | 1205931490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 39009) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4951) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-08 |