| NPI | 1780036491 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019035100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.151306) |
| 207Q00000X Family Medicine (Licence: AK 149554) | |
| 207Q00000X Family Medicine (Licence: HI MD-20722) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2023-03-01 |