| NPI | 1417185232 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101018350) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 59923-21) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2023-04-20 |