| NPI | 1902925365 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 4510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 18509) |
| 207Q00000X Family Medicine (Licence: MN 49315) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2013-10-29 |