| NPI | 1407416159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102206987) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019400) |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2025-08-12 |