| NPI | 1649623711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05050) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10751) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2019-07-11 |