| NPI | 1962794545 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-00904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 258499) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2015-05-27 |