| NPI | 1710120316 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2018-02852) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 1103) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2019-06-15 |