| NPI | 1770787178 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101015250) |
| Additional Taxonomies | 202K00000X (Licence: MI 5101015250) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2016-01-29 |