| NPI | 1790766681 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 33438) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 7165) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2021-12-22 |