| NPI | 1710958343 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 11415) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 11415) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2021-07-21 |