| NPI | 1104213107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10654) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2022-06-23 |