| NPI | 1902117039 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-00111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203609) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2021-09-29 |