| NPI | 1902243215 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 100771-875) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408172) |
| 207Q00000X Family Medicine (Licence: IL 036140601) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2023-12-08 |