| NPI | 1477964930 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-02051) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101021326) |
| Enumeration Date | 2014-05-17 |
| Last Update Date | 2025-02-11 |