| NPI | 1588926372 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 75737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9358) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2021-09-13 |