| NPI | 1710321807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 63595) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 63595-020) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2022-04-12 |