| NPI | 1104356757 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020033778) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301112969) |
| 207Q00000X Family Medicine (Licence: MI 4351034526) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-10-13 |