| NPI | 1700059417 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 14467) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7741A) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2014-10-02 |