| NPI | 1811352065 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME154196) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 51027) |
| Enumeration Date | 2015-12-15 |
| Last Update Date | 2022-09-18 |