| NPI | 1750320917 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 2001-40) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 29739) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2012-12-04 |