| NPI | 1760688204 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA 0S014357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT011584) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2018-11-12 |