NPI | 1073905121 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 14272) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 79709) |
2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: FL 14272) | |
Enumeration Date | 2015-02-26 |
Last Update Date | 2025-09-09 |