| NPI | 1366535056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD 0041780) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD 072565L) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2011-10-28 |