| NPI | 1417241621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 4514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9213) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2014-02-20 |