| NPI | 1689907024 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MD D0060307) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: VA 0101235327) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2009-09-17 |