| NPI | 1871792051 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.206930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M11130) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2016-03-23 |