| NPI | 1770716938 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102202732)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 192120)  | 
| 207Q00000X Family Medicine (Licence: NC 192120)  | |
| 207P00000X Emergency Medicine (Licence: VA 0102202732)  | |
| Enumeration Date | 2009-09-03 | 
| Last Update Date | 2014-03-25 |