| NPI | 1124507926 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 69986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101278729) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2023-08-02 |