| NPI | 1619305174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME92761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 35379) |
| 207Q00000X Family Medicine (Licence: NY 263617) | |
| 207Q00000X Family Medicine (Licence: VA 0101047114) | |
| Enumeration Date | 2013-10-21 |
| Last Update Date | 2013-10-21 |