| NPI | 1669096335 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 20273) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151014419) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2026-06-29 |