| NPI | 1114136074 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 50580-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-7517) |
| 207Q00000X Family Medicine (Licence: IA 38059) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-09-10 |