| NPI | 1629186614 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 308952) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301073047) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-05-11 |