| NPI | 1679524896 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 14756) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 8002) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2018-05-08 |