| NPI | 1255772257 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA R9805) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 10028) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2025-11-02 |