| NPI | 1982099420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD185321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 65981-20) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2021-09-09 |