| NPI | 1982626735 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0110001278) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001278) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |