| NPI | 1457355042 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101012728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS8643) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2017-03-08 |