| NPI | 1750458964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD162119) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 36168) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2015-02-19 |