| NPI | 1609854124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NC 94-00819) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036139295) |
| 207Q00000X Family Medicine (Licence: KY 24786) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2018-03-17 |