| NPI | 1760896161 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME129437) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN 19938) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2021-11-13 |