| NPI | 1982915633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 88463) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 45976) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2021-08-16 |