| NPI | 1699831016 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 63200-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD431033) |
| 207Q00000X Family Medicine (Licence: KS 04-35965) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2026-09-15 |