| NPI | 1053759035 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5315059352) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2018-03-29 |