| NPI | 1710115605 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1167) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101018234) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2015-09-17 |