| NPI | 1104206895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 56116) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10211) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2019-03-25 |