| NPI | 1265875603 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 54024) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2016-0669) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2019-06-12 |