| NPI | 1508506056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC MD77902) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL87902) |
| 207Q00000X Family Medicine (Licence: KY 60889) | |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-07-16 |