| NPI | 1902426257 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101027845) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 4158) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2024-04-16 |