| NPI | 1558865022 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2025-02290) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102206721) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-10-28 |