| NPI | 1679860597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 10666A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 40402) |
| 207Q00000X Family Medicine (Licence: IA R9279) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2023-01-19 |