| NPI | 1710249412 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS15901) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116024771) |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2019-04-22 |