| NPI | 1063686574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64825-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 48214) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2020-11-17 |