| NPI | 1215918164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 12805) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 12805) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2015-07-07 |