| NPI | 1578549143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 36506) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 11085) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2020-10-29 |