| NPI | 1760511562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD167249) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 9145) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2015-04-29 |