| NPI | 1508153867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 65053) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2014-00863) |
| 207Q00000X Family Medicine (Licence: TX P4068) | |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2016-03-15 |