| NPI | 1962583617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C135085) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 48550) |
| 207Q00000X Family Medicine (Licence: NM MD20070158) | |
| 207Q00000X Family Medicine (Licence: WI 48578-020) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2021-05-11 |