| NPI | 1720642655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2024-0839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD211048) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2024-10-24 |