| NPI | 1386610509 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-25856) | 
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: KS 05-25856) | 
| Enumeration Date | 2006-02-27 | 
| Last Update Date | 2017-04-04 |