| NPI | 1972065589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME153922) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101273105) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2022-06-30 |