| NPI | 1649711854 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 85276-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 14934A) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2025-07-14 |