| NPI | 1376973156 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME124639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN19121) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2018-05-08 |