| NPI | 1407150436 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ZZ 84301) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 246427) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2011-11-22 |