| NPI | 1255698056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101287260) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 62195) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2025-12-01 |