| NPI | 1720569973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 21119) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL 1123) |
| Enumeration Date | 2018-08-26 |
| Last Update Date | 2020-04-14 |