| NPI | 1265961114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-2410-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM R-25-2017) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2020-12-11 |