| NPI | 1902167901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A168579) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10043378) |
| 208D00000X General Practice (Licence: MI 4301108934) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2021-08-19 |