| NPI | 1538270970 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 11039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 22128) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |