| NPI | 1265953319 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017022311) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2019-0837) |
| 207Q00000X Family Medicine (Licence: MO 2018029145) | |
| 207Q00000X Family Medicine (Licence: NM C500228633) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2020-06-22 |