| NPI | 1780762724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS0006393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101010681) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-04-11 |