| NPI | 1104265016 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 75308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 006482) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2025-06-03 |