| NPI | 1649349564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL os17159) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 49866) |
| 207Q00000X Family Medicine (Licence: IL 036-108672) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-09-14 |