| NPI | 1639343973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 57265-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008026576) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2012-07-16 |