| NPI | 1508506056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 60889) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL87902) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2025-07-01 |