| NPI | 1902904345 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60428736) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 220410) |
| 207Q00000X Family Medicine (Licence: LA 14297R) | |
| 207Q00000X Family Medicine (Licence: AK 5802) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-02-07 |