| NPI | 1952629867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 2864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 2608) |
| 207Q00000X Family Medicine (Licence: NC 2013-00958) | |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2018-12-13 |