| NPI | 1881954469 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD206288) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015031854) |
| 207Q00000X Family Medicine (Licence: WI 4489-850) | |
| 207Q00000X Family Medicine (Licence: NC 2020-01163) | |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2022-04-26 |