| NPI | 1255654240 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 46478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 3944) |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2013-05-21 |