| NPI | 1063015311 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 22590) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PR 195-P.A.) |
| Enumeration Date | 2020-11-19 |
| Last Update Date | 2023-01-18 |