| NPI | 1659632842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134540) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.208072) |
| 207Q00000X Family Medicine (Licence: VA 0116024681) | |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2026-05-06 |