| NPI | 1578943239 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME12001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN 21361) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2023-11-14 |