| NPI | 1639140742 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101 007810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200401569) |
| 207Q00000X Family Medicine (Licence: FL OS10821) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2015-05-18 |