| NPI | 1780714071 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 8204) |
| Additional Taxonomies | 174400000X Specialist (Licence: MT 8204) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2019-07-05 |