| NPI | 1902025729 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 03845) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101016039) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2018-03-17 |