| NPI | 1962798330 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CO 53811) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10040048) |
| 208D00000X General Practice (Licence: TX P4525) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2015-09-15 |