| NPI | 1972849891 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 16566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 35924) |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2021-11-23 |