| NPI | 1528096146 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 12588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 34204) |
| 207Q00000X Family Medicine (Licence: NM 0903) | |
| 207Q00000X Family Medicine (Licence: IL 161340) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2022-11-07 |