| NPI | 1790718971 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 65375) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301081315) |
| 207Q00000X Family Medicine (Licence: TN MD0000047548) | |
| 207Q00000X Family Medicine (Licence: SC 39945) | |
| 207Q00000X Family Medicine (Licence: OH 35.082537) | |
| 207Q00000X Family Medicine (Licence: CA 165125) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2021-01-13 |