| NPI | 1700871159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301080134) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 23324-875) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2023-02-06 |