| NPI | 1508850603 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 31265) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 5316) |
| 207Q00000X Family Medicine (Licence: NE 1453) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2011-01-31 |