| NPI | 1730755513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-06692) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 81530) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2024-07-30 |