| NPI | 1912293200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME153809) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 72884) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2021-12-02 |