| NPI | 1679764542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202432) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116019842) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2021-04-05 |