| NPI | 1629530548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101286740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 69268) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-11-18 |