| NPI | 1891904645 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 64483) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 64483) |
| 208D00000X General Practice (Licence: NC 2006-01268) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2022-11-18 |