| NPI | 1700930021 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NE 16086) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CO 25127) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |