| NPI | 1609862721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 1488) |
| Additional Taxonomies | 208800000X Urology (Licence: WV 1488) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2017-12-18 |