| NPI | 1154734853 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2025-0793) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 260196) |
| 207Q00000X Family Medicine (Licence: IL 036.145992) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2025-09-26 |