| NPI | 1609853803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-00738) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K7897) |
| 207Q00000X Family Medicine (Licence: VA 0101244654) | |
| 207Q00000X Family Medicine (Licence: FL ME 112063) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2014-08-19 |