| NPI | 1740661594 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 081040) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME136742) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2018-08-02 |