| NPI | 1699260620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 12448138-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.072499) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2021-12-10 |