NPI | 1306266119 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: MO 2018026842) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX Q7092) |
Enumeration Date | 2014-04-18 |
Last Update Date | 2022-01-12 |