| NPI | 1730168600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101056308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD457136) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2016-09-06 |