| NPI | 1043211451 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-116680) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M3137) |
| 207Q00000X Family Medicine (Licence: NH 11749) | |
| 207Q00000X Family Medicine (Licence: WI 54953-21) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2019-12-19 |