| NPI | 1356571459 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101252634) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6169) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2022-06-09 |