| NPI | 1548429863 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A102687) |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: CA A102687) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2018-03-17 |