| NPI | 1003179532 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-00535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL34760) |
| 207Q00000X Family Medicine (Licence: CO DR.0060018) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-05-11 |