| NPI | 1639152291 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4155) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101015264) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2015-05-12 |