| NPI | 1457627390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VT 0990084266) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CT 000479) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2022-03-16 |