| NPI | 1801159504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 9407925) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD470623) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-01-02 |