| NPI | 1669475224 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-24572) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R4P05) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2023-08-14 |