| NPI | 1336125939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 51915-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 42881) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2022-01-18 |