| NPI | 1518090794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TN MD0000026924) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 30631) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |