| NPI | 1083666101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301104391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 051207) |
| 207Q00000X Family Medicine (Licence: NE 26361) | |
| 207Q00000X Family Medicine (Licence: CO 47259) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2014-02-21 |