| NPI | 1720003122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 35223) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 47848) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-08 |