| NPI | 1649775149 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301505081) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 71740) |
| 207Q00000X Family Medicine (Licence: WI 71740-20) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2021-08-20 |