| NPI | 1356652556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 52228) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250590) |
| 207Q00000X Family Medicine (Licence: FL ME136558) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2022-04-19 |