| NPI | 1972866010 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS12436) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO3111) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2022-07-21 |