| NPI | 1558711689 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME138582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN 23166) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2021-09-15 |