| NPI | 1821259961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 232160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME150620) |
| 207Q00000X Family Medicine (Licence: AL MD.30795) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2021-09-23 |