| NPI | 1790047900 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 63914-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL 34569) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2024-08-01 |