| NPI | 1962511295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME83251) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2003-0135) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-04-27 |