| NPI | 1679320998 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL 1734) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 24511) |
| Enumeration Date | 2024-05-03 |
| Last Update Date | 2025-10-09 |