| NPI | 1700802428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 7114A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM NM 75-203) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-08 |