| NPI | 1730590258 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-03450) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 24556) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2024-01-09 |