| NPI | 1811334501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 66119-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101020593) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2016-08-30 |