| NPI | 1659433951 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 17750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101051600) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2019-01-24 |