| NPI | 1790824738 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 60919) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2005-0276) |
| 207Q00000X Family Medicine (Licence: WI 64831-20) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-10-21 |