| NPI | 1376956219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14284) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO 4131) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2019-11-20 |