| NPI | 1962493718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: WI 64279-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301051670) |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2018-11-02 |