| NPI | 1053870063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 4584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 87810) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-03-27 |