| NPI | 1679860639 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101255276) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 4301098393) |
| 207Q00000X Family Medicine (Licence: MI 4301098393) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2020-04-23 |