| NPI | 1659668218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M13891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 94-07773) |
| 207Q00000X Family Medicine (Licence: WV 26025) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2025-10-21 |