| NPI | 1790010668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2014006969) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53691) |
| 207Q00000X Family Medicine (Licence: WV 53691) | |
| Enumeration Date | 2009-10-12 |
| Last Update Date | 2023-06-13 |