| NPI | 1811251259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-38387) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015032063) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2019-12-30 |