| NPI | 1164835054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205727) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A15564) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2021-05-26 |