| NPI | 1295475200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 111362) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2026-01633) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-08-03 |