| NPI | 1902991458 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 312299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 88691) |
| 207Q00000X Family Medicine (Licence: CA A78596) | |
| 207Q00000X Family Medicine (Licence: MN 48415) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-06-22 |