| NPI | 1245679760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-39367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2013019109) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2016-09-14 |