| NPI | 1659365062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 33188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101038503) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2020-10-28 |