| NPI | 1114206059 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 119903) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0427083) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2016-06-23 |