| NPI | 1780895292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-01354) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016472) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2021-03-24 |