| NPI | 1255861514 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 88472) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO1660) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2026-01-02 |