| NPI | 1205120805 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60407944) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-059952) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2014-11-21 |