| NPI | 1700877412 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1770) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 1770) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2009-04-24 |