| NPI | 1619090578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 054023) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 52410-020) |
| 207Q00000X Family Medicine (Licence: FL ME107540) | |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2021-06-04 |