| NPI | 1942287628 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 42772) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 45683-020) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2012-12-19 |