| NPI | 1609189638 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 23900-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 49864) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2014-03-05 |