| NPI | 1659692192 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-36400) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: KS 04-36400) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2021-09-22 |