| NPI | 1679766000 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME137555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT196360) |
| 207Q00000X Family Medicine (Licence: NH 17660) | |
| 207Q00000X Family Medicine (Licence: VA 0101255972) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: NH 61-4719) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2021-09-15 |