| NPI | 1639166986 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-21959) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0521959) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2014-06-04 |