| NPI | 1922488956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 3100) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV training) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2020-01-20 |