| NPI | 1528475621 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME.137326) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-47098) |
| 207Q00000X Family Medicine (Licence: MI 4301106118) | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2021-05-12 |