| NPI | 1770905770 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 312000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 61985) |
| 207Q00000X Family Medicine (Licence: IL 125064306) | |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2019-06-25 |