| 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) | |
| 207Q00000X Family Medicine (Licence: VA 0102209799) | |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2025-12-03 |