| NPI | 1780754457 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-02290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD21536) |
| 207Q00000X Family Medicine (Licence: MO 2004021603) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2022-10-05 |