| NPI | 1548641871 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 83144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-02717) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2021-07-19 |