| NPI | 1619331089 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 322193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 7777777) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2020-07-27 |