| NPI | 1770715047 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN380) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17667) |
| 261QP2400X Clinic/Center, Prison Health (Licence: FL ACN380) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2022-06-05 |