| NPI | 1538419759 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME155578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101261476) |
| 207Q00000X Family Medicine (Licence: MI 4301100588) | |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2022-08-05 |