| NPI | 1689929655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101272296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 53931) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2022-05-09 |