| NPI | 1104481555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M15981) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1815) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2022-06-06 |