| NPI | 1659645059 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102203378) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116023969) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2020-11-05 |