| NPI | 1790778504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A8487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 5560) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2011-11-29 |