| NPI | 1104933654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 39095-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 33493) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-03-07 |