| NPI | 1700099819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301088217) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2022-08-25 |