| NPI | 1104955632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200900819) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 134118) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2023-03-07 |