| NPI | 1609964196 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101037236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A-39916) |
| 207Q00000X Family Medicine (Licence: PA MD-026246-E) | |
| 207Q00000X Family Medicine (Licence: AK 3236) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |