| NPI | 1508862475 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 51571) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD25057) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2015-05-08 |