| NPI | 1588026025 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 68311-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 141982) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2021-01-14 |