| NPI | 1629068127 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 239601) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41521) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2013-06-21 |