| NPI | 1194573030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 24601) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 2130) |
| Enumeration Date | 2024-05-07 |
| Last Update Date | 2025-08-18 |