| NPI | 1194724922 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PR 12843) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 12843) |
| 207Q00000X Family Medicine (Licence: PR 12843) | |
| 208D00000X General Practice (Licence: WV 22576) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2026-03-30 |