| NPI | 1992965651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301109120) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD 2011-0757) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2017-01-18 |