| NPI | 1508160870 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60196865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 25MA08639400) |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2011-07-01 |