| NPI | 1588863112 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101245461) |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: VA 0101245461) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2025-08-28 |