| NPI | 1508928821 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101254878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 73173) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NV 11798) | |
| 207Q00000X Family Medicine (Licence: HI MD-14790) | |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: NC 2005-00432) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-04-17 |