| NPI | 1326485012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301110782) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 49634) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2021-09-10 |