| NPI | 1912256512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0013345) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H0079082) |
| 207Q00000X Family Medicine (Licence: PA OT014873) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2019-10-29 |