| NPI | 1578640561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 48169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101240169) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-06-29 |