| NPI | 1598261596 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16370)  | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102206207)  | 
| Enumeration Date | 2018-03-30 | 
| Last Update Date | 2024-03-01 |