| NPI | 1134501067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 31772 R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME135664) |
| Enumeration Date | 2015-06-27 |
| Last Update Date | 2026-04-30 |