| NPI | 1710220132 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205293) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3087) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2019-10-22 |