| NPI | 1558347062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME71208) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.30622) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2011-12-12 |