| NPI | 1114614179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102208995) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116038217) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2025-08-07 |