| NPI | 1912361452 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 58650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101271263) |
| 207Q00000X Family Medicine (Licence: WI 68602) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2023-10-26 |