| NPI | 1033107636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015008169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 42911) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2021-03-05 |