| NPI | 1619139029 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2011-00731) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 30965) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2019-02-05 |