| NPI | 1497019608 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 74701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301101452) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2019-10-04 |