| NPI | 1336899012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2025031207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2023-03367) |
| 207Q00000X Family Medicine (Licence: KS 05-51358) | |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2025-08-12 |