| NPI | 1669644001 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101258982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 24028) |
| Enumeration Date | 2008-03-26 |
| Last Update Date | 2017-05-10 |