| NPI | 1457579500 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0320075457) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 1123) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2012-09-13 |