| NPI | 1720494602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ZZ 98408) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 261111) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2015-04-21 |