| NPI | 1720062458 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 16706) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 2801-16706) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2017-03-16 |