| NPI | 1417303199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 85269) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-00417) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2020-12-08 |