| NPI | 1720030653 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME92380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2023-00427) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-08-04 |