| NPI | 1962884411 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 80158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 38099) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2021-01-07 |