| NPI | 1720571763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2022-0326) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018018320) |
| 207Q00000X Family Medicine (Licence: MI 4301503639) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2022-10-10 |