| NPI | 1487248506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 2583) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 2583) |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-09-16 |