| NPI | 1821251349 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 29901) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ZZ 21210) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2015-06-03 |