| NPI | 1174378673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 10398) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 1780) |
| Enumeration Date | 2024-04-19 |
| Last Update Date | 2024-09-29 |