| 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 |