| NPI | 1366443392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200500019) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME104131) |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2020-10-25 |