| NPI | 1679509707 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 28070) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 14900) |
| 207Q00000X Family Medicine (Licence: AL 18544) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2007-08-27 |