| NPI | 1578558094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 11962) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101231026) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2016-01-11 |