| NPI | 1396978979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IL 036130663) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: IL 036130663) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2024-07-16 |