| NPI | 1407620602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 23660) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: PR 001360) |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2024-02-19 |