| NPI | 1750711636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME118534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301500706) |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2021-08-25 |