| NPI | 1659565356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101246376) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 17293) |
| 207Q00000X Family Medicine (Licence: FL ME 103483) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2014-10-03 |