| NPI | 1184157158 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 75675) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 6474) |
| 207Q00000X Family Medicine (Licence: MO 2020020964) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2021-11-01 |