| NPI | 1619239365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02274) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9407836) |
| 207Q00000X Family Medicine (Licence: KS 05-37449) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2022-02-10 |