| NPI | 1790748523 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 41681-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD09373) |
| 208D00000X General Practice (Licence: TX Q2236) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2021-01-13 |