| NPI | 1134579493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 73535) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10657) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2021-11-24 |