| NPI | 1760581490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M2852) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-433) |
| 207Q00000X Family Medicine (Licence: ID M6006) | |
| 363A00000X Physician Assistant (Licence: ID PA433) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2009-12-30 |