| NPI | 1578212890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-03018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 310140) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2025-08-25 |