| NPI | 1063669604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60099264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125051230) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2020-12-07 |