| NPI | 1073997102 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME130178) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 31591) |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2026-05-18 |