| NPI | 1619975836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.204152) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN MD29747) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2011-02-14 |