| NPI | 1003870817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0530647) |
| Additional Taxonomies | 251T00000X PACE Provider Organization |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2026-05-18 |