| NPI | 1730779984 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 12125021-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301117278) |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2022-06-01 |