| NPI | 1104506211 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 2023029385) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2023029385) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2024-07-11 |