| NPI | 1578519161 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 61376) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 20082) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2016-01-06 |