| NPI | 1649790858 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 73622-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.070919) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-07-21 |