| NPI | 1720774482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 8171847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101289619) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2026-07-30 |