| NPI | 1386932838 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2022-02686) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL33593) |
| 207Q00000X Family Medicine (Licence: VA 0101268409) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2026-06-17 |