| NPI | 1063824761 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CT 66720) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL OS15147) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2020-10-02 |