| NPI | 1730593898 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-02031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301105793) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2019-03-19 |