| NPI | 1306817259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-01589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101222161) |
| 207Q00000X Family Medicine (Licence: TN 42113) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2019-04-15 |