| NPI | 1578807442 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60439195) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125059208) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2022-02-04 |