| NPI | 1558365049 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 34703) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 34703) |
| 207Q00000X Family Medicine (Licence: GA 74480) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2026-04-29 |