| NPI | 1972864635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 263139) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2020-10-26 |