| NPI | 1679836597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 83822) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 25893) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2020-07-06 |