| NPI | 1790814762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301089418) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD22775) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2021-02-18 |