| NPI | 1780104604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 41047) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL41047) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2020-12-23 |