| NPI | 1265870778 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS 12980) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO 3690) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2021-02-12 |