| NPI | 1396196754 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 84920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 59842) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2021-04-23 |