| NPI | 1275830796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101255606) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301097847) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2019-12-06 |