| NPI | 1487628061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 6990) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 690) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2011-01-06 |