| NPI | 1861952939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 73865) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 8000) |
| 207Q00000X Family Medicine (Licence: WI 73865-20) | |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2020-10-14 |