| NPI | 1114542420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116034140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD70074285) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2026-04-22 |