NPI | 1104236942 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 30169) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S1613) |
207Q00000X Family Medicine (Licence: PA MD458848) | |
Enumeration Date | 2014-05-01 |
Last Update Date | 2021-10-23 |