| NPI | 1902286867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 57054) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN21672) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2018-10-18 |