| NPI | 1316268816 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101020719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116022581) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2013-08-20 |