| NPI | 1104350990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 75886) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61052133) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: OR MD219147) | |
| 207Q00000X Family Medicine (Licence: OH 35C.002929) | |
| 207Q00000X Family Medicine (Licence: IN 01097311A) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2025-09-18 |