| NPI | 1790759132 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-01966) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101053631) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-01-26 |