| NPI | 1720469539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 70318-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301107823) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-04-19 |