| NPI | 1881957470 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME148863) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 18444) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-11-19 |