| NPI | 1609905876 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200700246) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 2260) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2023-02-14 |