| NPI | 1821021114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR 21815) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2006018519) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2018-09-25 |