| NPI | 1699153528 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 87020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 210102) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2022-03-22 |