| NPI | 1639125859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2008-01139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4892) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-01-13 |