| NPI | 1629484704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA ND659) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 12-1345) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2014-07-09 |