| NPI | 1366963068 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142047) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN24273) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2021-12-10 |