| NPI | 1508018128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301093159) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014039905) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2015-06-01 |