| NPI | 1619180668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR D0150808) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016061) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2019-12-17 |