| NPI | 1255329173 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4710) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101009622) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2019-07-10 |