| NPI | 1609885698 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2009-01358) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301070450) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2024-01-19 |