| NPI | 1649341892 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 102714) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CO 1482) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2025-06-15 |