| NPI | 1962848085 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: KS 04-39185) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 9408117) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2018-01-24 |