| NPI | 1861837619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2017028721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9639) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2020-11-25 |