| NPI | 1639374960 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 11698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND TRL10631) |
| 207Q00000X Family Medicine (Licence: ND PT11698) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2026-07-01 |