| NPI | 1417373986 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 81620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 25215) |
| 207Q00000X Family Medicine (Licence: WV 3393) | |
| Enumeration Date | 2014-03-08 |
| Last Update Date | 2020-02-21 |