| NPI | 1649619198 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301110197) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.063411) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2020-05-06 |