| NPI | 1962451518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 307654) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 12887) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2018-05-10 |