| NPI | 1578122289 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101285050) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 331546) | 
| Enumeration Date | 2019-06-07 | 
| Last Update Date | 2025-06-05 |