| NPI | 1760611917 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2009012955) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 55406-021) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2023-01-09 |