| NPI | 1740507151 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-00746) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: NC 2013-00746) |
| Enumeration Date | 2010-04-24 |
| Last Update Date | 2013-07-16 |