| NPI | 1164719548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 64714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301099290) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2022-02-10 |