| NPI | 1619104916 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2012-053) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 241082) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2015-09-25 |