| NPI | 1255310074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 13653) |
| 207Q00000X Family Medicine (Licence: FL ACN1017) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2021-06-02 |