| NPI | 1295096741 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116024422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-01512) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2021-05-10 |