| NPI | 1114547452 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LL94632) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 324837) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2025-07-16 |