| NPI | 1669739041 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301109212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101258710) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2023-04-04 |