| NPI | 1457615635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 38069) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012020294) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2021-01-04 |