| NPI | 1174973762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 82296) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101267729) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2020-06-11 |