| NPI | 1356548366 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101241486) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: VA 0101241486) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2018-11-05 |