| NPI | 1083778252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: MI 4301080151) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301080151) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-03-12 |