| NPI | 1053676593 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015025846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6830) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2020-11-19 |