| NPI | 1770572547 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WV 14498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 14498) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2020-07-13 |