| NPI | 1528256963 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CO 49201) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: IL 136126013) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2012-10-03 |