| NPI | 1245890615 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS24158) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 05147) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2026-10-01 |