| NPI | 1992917959 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME122085) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 192494) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2016-06-29 |