| NPI | 1649654591 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 4764) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 7674) |
| 207Q00000X Family Medicine (Licence: NC 2018-00768) | |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2022-10-13 |