| NPI | 1962851972 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 71632) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.068690) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2026-01-12 |