| NPI | 1699706119 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301078902) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 46165-20) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-09-27 |