| NPI | 1760462311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MD 26669) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2001-01321) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2008-07-03 |