| NPI | 1710250733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO191839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 262283) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2020-11-03 |