| NPI | 1558439554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME108518) |
| Additional Taxonomies | 261QE0002X Clinic/Center, Emergency Care (Licence: NC 01287) |
| 261QE0002X Clinic/Center, Emergency Care (Licence: NY 221914) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2011-10-14 |