NPI | 1821010265 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 06133r) |
Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: LA 562439708) |
Enumeration Date | 2006-07-24 |
Last Update Date | 2012-07-27 |