| NPI | 1700107471 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 15111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS016244) |
| 207Q00000X Family Medicine (Licence: PA OT013690) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2018-03-28 |