| NPI | 1255620084 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME112054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN15490) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2013-12-02 |