| NPI | 1790073542 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-39194) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2012023670) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2023-01-24 |