| NPI | 1629365382 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD168177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301099346) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2021-03-09 |