| NPI | 1700839859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200401649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 3811) |
| 207Q00000X Family Medicine (Licence: MA 237887) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2021-05-06 |