| NPI | 1700966835 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME94330) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME94330) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2011-09-07 |