| NPI | 1689610842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-11487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420011033) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2012-05-03 |