| NPI | 1700840915 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-35910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R5P55) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2016-02-11 |