| NPI | 1679853139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 257983) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 199969) |
| Enumeration Date | 2011-08-27 |
| Last Update Date | 2014-10-06 |