NPI | 1710252069 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.206595) |
Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: LA 206595) |
Enumeration Date | 2012-03-20 |
Last Update Date | 2020-09-24 |