| NPI | 1821011933 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 61168) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2005-0683) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2014-01-13 |