| NPI | 1952789745 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 86353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101022070) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2023-05-23 |