| NPI | 1811086762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD28074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301081301) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2021-03-22 |