| NPI | 1053503789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 124565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301090904) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2019-01-29 |