| 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 |