| NPI | 1326440983 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 68353-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101021472) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2017-12-28 |