| NPI | 1972589976 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD181506) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 0420010400) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2017-05-19 |