| NPI | 1982197893 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME151022) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.072895) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2022-01-17 |