| NPI | 1083813596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036-129908) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 248893) |
| 207Q00000X Family Medicine (Licence: WI 56542-20) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2013-01-28 |