| NPI | 1720107782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 309608-01) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 66372-20) |
| 207Q00000X Family Medicine (Licence: VA 0101267019) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2021-06-23 |