| NPI | 1720565336 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 234893) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125-073-419) | 
| 207Q00000X Family Medicine (Licence: IL 036.159226) | |
| Enumeration Date | 2018-07-26 | 
| Last Update Date | 2025-09-10 |