| NPI | 1063803377 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5601007300) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2025-12-18 |