| NPI | 1114389541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 27264) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 321305) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2020-01-16 |