| NPI | 1619395506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 78519) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA 129458) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2024-03-12 |