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 |