| NPI | 1053765685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 036147068) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.069021) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2026-07-29 |