| NPI | 1962547919 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 39725) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 33164) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2011-10-04 |