| NPI | 1790980456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD151231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A107224) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2011-06-04 |