| NPI | 1811302375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 67314) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-09910) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2018-02-09 |