| NPI | 1902130545 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301101905) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 22033) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2021-02-09 |