| NPI | 1629484373 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME140610) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101261293) |
| 207Q00000X Family Medicine (Licence: GA 78443) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2020-09-10 |