| NPI | 1710912969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 20177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2025001821) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2025-07-03 |