| NPI | 1063994382 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 06084) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO6338) |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2025-07-02 |