| NPI | 1740579333 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-45572) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 60751-20) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2022-08-29 |