| NPI | 1497582142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC 1054288) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0024191048) |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-09-17 |