| NPI | 1568654101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME126706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A124251) |
| 207Q00000X Family Medicine (Licence: OR MD150544) | |
| 207Q00000X Family Medicine (Licence: MI 4301090806) | |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2018-09-06 |