| NPI | 1578123915 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5151013633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 13578) |
| 207Q00000X Family Medicine (Licence: IA DO-06010) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2025-08-11 |