| NPI | 1770874430 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD166590) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301097570) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2021-11-15 |