| NPI | 1659666022 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0436015) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7614) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2014-09-17 |