| NPI | 1972668630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301065126) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME97637) |
| Enumeration Date | 2006-12-23 |
| Last Update Date | 2014-11-19 |