| NPI | 1861768350 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102204114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO0000002677) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2015-10-08 |