| NPI | 1639695489 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 0010-07472) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07472) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2025-08-07 |