| NPI | 1154373090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5315048052) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 45292) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2019-06-28 |