| NPI | 1720077696 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD150824) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2002-0101) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2021-06-25 |