| NPI | 1801117122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101251657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116022450) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2021-10-10 |