| NPI | 1790045870 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME139001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101254606) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2019-11-08 |