| NPI | 1821030834 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200300473)  | 
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 200300473)  | 
| Enumeration Date | 2006-06-12 | 
| Last Update Date | 2008-05-21 |