| NPI | 1568812535 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-47704) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016020771) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2023-10-25 |