| NPI | 1912906686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 81467) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35068277) |
| 207Q00000X Family Medicine (Licence: MI 4595588) | |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2008-07-02 |