| NPI | 1184911067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 137417) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.135636) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2020-09-16 |